bmj.com -- Press Releases

Releases Saturday 11 March 2000
No 7236 Volume 320

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(1) PREVENTING CORONARY HEART DISEASE BY
ASSESSING ABSOLUTE RISK

(2) MORE EFFICIENT BLOOD PRESSURE TREATMENT
WOULD DRAMATICALLY CUT HEART DISEASE

(3) THE HEALTH NEEDS OF CHILDREN IN CARE ARE
NEGLECTED

(1) PREVENTING CORONARY HEART DISEASE BY
ASSESSING ABSOLUTE RISK

(Guidelines on preventing cardiovascular disease in clinical
practice)
http://www.bmj.com/cgi/content/full/320/7236/659

In the week that the Government launches its National
Service Framework for tackling coronary heart disease, the
BMJ publishes a series of papers on the assessment of
patients' risk of developing heart disease.

In an editorial, Rod Jackson, professor of epidemiology at
the University of Auckland's Department of Community
Health, supports British clinical guidelines that say priority for
treatment should be given to patients at high absolute risk of
coronary heart disease, rather than focusing on individual risk
factors.

(2) MORE EFFICIENT BLOOD PRESSURE TREATMENT
WOULD DRAMATICALLY CUT HEART DISEASE

(Using thresholds based on risk of cardiovascular disease to
target treatment for hypertension: modelling events averted
and number treated)
http://www.bmj.com/cgi/content/full/320/7236/680

If treatment for blood pressure was more efficiently targeted,
cases of heart disease and stroke could be cut by more than
two thirds compared with current treatment, suggests a study
in this week's BMJ.

Jackson and colleagues, from the University of Auckland's
Department of Community Health, estimated how many
people would need to be treated for raised blood pressure
and how much death and disease could subsequently be
avoided over the next five years.

This was done by calculating the five year risk of heart
disease and stroke among a representative sample of over
2,000 men and women aged between 35 and 79 and then
applying the results to the region as a whole. Treatment
"thresholds" were set according to predicted risk over the
next five years.

The results showed that the lower the risk, the greater the
numbers of patients requiring treatment, but the greater the
reduction in death and disease. A 10 per cent risk would
mean an additional 20,000 patients treated set against a more
than two thirds (68%) reduction in death and disease. And
this would principally be among men over the age of 65, a
group currently considered to be "undertreated". A 15 per
cent risk threshold would cut cardiovascular disease by just
over a third, boosting those needing treatment by an extra 10
per cent.

Treatments to lower blood pressure would be much more
effective if they were based on risk thresholds rather than
current criteria, conclude the authors.

Contact:

Professor Rod Jackson, Department of Community Health,
University of Auckland
Email: rt.jackson{at}auckland.ac.nz

(3) THE HEALTH NEEDS OF CHILDREN IN CARE ARE
NEGLECTED

(Promoting the health of looked after children)
http://www.bmj.com/cgi/content/full/320/7236/661

Children coming into the care system are amongst the most
vulnerable in society. As well as health needs which often
stem from poverty, they may have undiagnosed health
problems, be suffering the effects of physical or sexual abuse
or neglect or may be in care because they are disabled and
their parents need help to cope.

Although the 1989 Children Act requires local authorities to
ensure that each child has an annual medical report, uptake of
health assessments can be as low as 25 per cent in some
authorities. Many young people refuse to attend and the
reports are often of poor quality. Children in care are often
excluded from school and therefore from the input of school
health services and unstable fostering means that children in
care spend long periods as temporary residents of general
practices.

In an editorial, Leon Polnay, professor of child health at
Queen's Medical Centre, Nottingham and Harriet Ward,
senior research fellow at Loughborough University, say that a
complete culture change, with designated and specially
trained doctors and nurses will be needed to achieve better
continuity of care for these children.

Contact:

Professor Leon Polnay, Division of Child Health, School of
Human Development, Queen's Medical Centre, University of
Nottingham Email: leon.polnay@nottingham.ac.uk

Harriet Ward, Senior Research Fellow, Department of Social
Sciences, Loughborough University
Email: h.ward{at}lboro.ac.uk

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